| 摘要: | 俞根初（1734–1799AD），紹興傷寒學派代表人物，清代中葉時期著名醫家。俞氏提出寒溫統一論，以及六經與三焦相結合的創見。俞氏的辨證理論，既別於一般傷寒學派，又異於吳門溫病學派，其所著《通俗傷寒論》為「四時感證之診療全書」。
為了解俞根初《通俗傷寒論》的學術思想以及處方用藥特色，本文先以歸納法分析俞根初《通俗傷寒論》不包含何氏祖孫、曹炳章等按語之原文內容，後以計量法分析〈六經方藥〉一節共101首方劑，分析其藥物種類、使用頻率、劑量比較。
俞氏學術思想主要受到《內經》、《傷寒論》，以及朱肱、陶華、張景岳、吳又可、喻嘉言、葉天士等醫家影響。俞氏認為外感百病皆屬傷寒，以廣義傷寒論立論，文中內容包含傷寒、溫病、雜病等，因強調辨證論治，故全書分四大證型有傷寒本證、兼證、夾證、壞證復證，其下又有許多小證，共約51證，並使用六經、三焦、八綱辨證等多樣性辨證法來辨證，更提出六經形層說以結合六經與三焦；診法上強調四診合參，重視目診與腹診，並以六經劃分舌脈象，來增加診斷準確率；治法上強調隨疾病進程，分階段及嚴重度來治療疾病，其治療方式除內服藥外，亦有針灸、刮痧、滴劑等外治法，且療疾、癒後都重視脾胃調理，以防疾病再發。
俞氏主張用藥寒溫合用，處方上不拘於傷寒方或是溫病方，亦擷取眾家之長如景岳、陶華、吳又可等方藥，且依病證輕重程度，分輕重用藥。其處方特色：（1）外感治療，辨證施方，（2）應用古方，善於化裁，（3）搭配丸散，加強療效，（4）依據治法，運用合方；其用藥特色：（1）因地制宜，強調化濕，（2）藥量精簡，常用花草，（3）稍加辛藥，加強藥效，（4）清宣心包，重則犀鈴。
俞根初《通俗傷寒論》一書完全體現中醫臨床辯證論治思想，而俞氏學術思想也影響了後代寒溫統一理論的興起，臨床上建議可仿效俞氏以增加臨床療效。
Yu Genchu (1734-1799AD), the represented scholar of Shaoxing Shanghan Xuepai, was a well- known physician in the middle age of Ching dynasty. He announced a theory of the cold-warm union, and the idea of six-channel integrated triple burner. Dr. Yu’s pattern of identification theory was different from scholar schools of Shanghan and Wu’s warm disease. His book, “Tongsu Shanghan Lun”, was a diagnosis and treatment book which could be used in externally contracted disease patterns during seasons.
The purpose of this study was to research Dr. Yu’s thought for treatment of externally contracted disease and analyze the character of his medication. The main study materials are Dr. Yu’s original work excluding the text of He Xiu-shan, He Lian-chen etc., and 101 prescriptions from the chapter of six-channel formulas in the book.
Dr. Yu’s thought was mainly affected by Nei Jin, Nan Jin, and other physicians like Zhu Gong, Tao Jie-An, Chang Jing-Yue, Wu You-Ke. Base on the thought of vacuity pattern of shanghan, the text contained Shanghan, warm disease and miscellaneous disease. He set up four main syndrome patterns which were Shanghan main syndrome, accompanied syndrome, combined syndrome, worse syndrome, and relapse syndrome, and other subdivided ones approximately 51syndromes. Emphasizing on treatment based on syndrome differentiation, Dr. Yu’s used multiple identification methods such as six-channel pattern, triple burner pattern and eight principles identification, and he announces six-channel shape level hypothesis, the idea of six-channel integrated triple burner. He also emphasized on synthesis of the four diagnostics, including eye and abdomen diagnosis, and he used six-channel pattern to divide pulse condition and tong appearance to increase the reliable diagnosis rate. He made treatment plans based on the disease process, and the medication including drug, acupuncture, Gua sha, and medicinal paste therapy. To avoid relapse he always placed importance on recuperating spleen and stomach during or after the treatment.
The characters of prescriptions by Dr. Yu’s such as (1) the treatment of externally contracted disease was based on identify patterns and administer prescriptions (2) easily changing the ancient formulas composition to treat diseases (3) combined with pills or powders to enhance the efficacy (4) combined formulas according to the principle of treatment. Dr. Yu’s character of drug use such as (1) drug use emphasized on dampness transformation according to the geographic environment (2) application of the drug use with lower dose and often using the plants and flowers (3) Adding few acrimonious drugs to enhance the efficacy (4) clearing the serious pericardial patterns with the heart and orifices-opening drug such as rhinoceros horn and antelope horn.
The study suggested that clinicians can follow the principles of prescription and drug use by Dr. Yu’s to reinforce their treatment effect. |
